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| ID | Type | Description | Link |
|---|---|---|---|
| IIR HX00257-01A1 | Other Grant/Funding Number | VA Health Services Research & Development |
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| Name | Class |
|---|---|
| Durham VA Health Care System | FED |
| VA Salt Lake City Health Care System | FED |
| Birmingham, Alabama VA Medical Center | FED |
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This research is being conducted to learn which implementation strategy of EQUIPPED is most effective to improve prescribing practices of ED providers toward older Veterans and determine the factors influencing implementation of this program to reduce the prescribing of PIMs to older adults upon discharge from the ED. The study has three research aims. The procedures for these research aims are described below:
Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. In order to inform a Veterans Affairs (VA) system-wide approach to improve prescribing safety for older Veterans, the investigators will conduct a study to determine best practices for influencing provider prescribing behavior in order to decrease PIMs prescribed for older Veterans at the time of ED discharge. The overall goal of this project is to determine which EQUIPPED implementation strategy (active or passive feedback) is most effective to reduce prescribing of PIMs for older Veterans discharged from the ED.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Active Feedback | Active Comparator | EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise. |
|
| Passive Feedback | Active Comparator | EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| EQUIPPED with Active Feedback | Other | Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The active feedback group will receive one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise. |
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of PIMs Prescribed | Percentage of prescriptions that are PIMS (potentially inappropriate medications) as defined according to the Beers criteria prescribed to adults aged 65 and older and discharged from the ED. | 12-Months Post Implementation of EQUIPPED |
| Measure | Description | Time Frame |
|---|---|---|
| Social Cognitive Theory Survey - Perceived Control Domain | Prescribers at participating EDs completed a survey at baseline, 6, and 12 months to assess perceived control related to prescribing as a factor that could be impacted by the EQUIPPED intervention. The outcome relates to the average reported perception of 'control' across site respondents by implementation group assignment. The 'perceived control' domain is assessed with a 1-5 Likert scale where 1=strongly disagree and 5=strongly agree with the statement, "I am in control of reducing the potentially inappropriate medications that I prescribe for older Veterans at the time of emergency department." |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Elizabeth Camille Vaughan, MD MS | Atlanta VA Medical and Rehab Center, Decatur, GA | Principal Investigator |
| George Lee Jackson, PhD MHA | Durham VA Medical Center, Durham, NC | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Birmingham VA Medical Center, Birmingham, AL | Birmingham | Alabama | 35233-1927 | United States | ||
| Atlanta VA Medical and Rehab Center, Decatur, GA |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32222360 | Result | Burningham Z, Jackson GL, Kelleher J, Stevens M, Morris I, Cohen J, Maloney G, Vaughan CP. The Enhancing Quality of Prescribing Practices for Older Veterans Discharged From the Emergency Department (EQUIPPED) Potentially Inappropriate Medication Dashboard: A Suitable Alternative to the In-person Academic Detailing and Standardized Feedback Reports of Traditional EQUIPPED? Clin Ther. 2020 Apr;42(4):573-582. doi: 10.1016/j.clinthera.2020.02.013. Epub 2020 Mar 25. | |
| 37648222 |
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A de-identified, anonymized dataset will be created and shared.
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Participants were EQUIPPED implementation team members or providers at EQUIPPED implementation sites.
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| ID | Title | Description |
|---|---|---|
| FG000 | Active Feedback | EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise. EQUIPPED with Active Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The active feedback group will receive one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise. |
| FG001 | Passive Feedback | EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. EQUIPPED with Passive Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
Participants were EQUIPPED implementation team members or providers at EQUIPPED implementation sites.
| ID | Title | Description |
|---|---|---|
| BG000 | Active Feedback | EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise. EQUIPPED with Active Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The active feedback group will receive one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Age was self-reported and not reported by all participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Percentage of PIMs Prescribed | Percentage of prescriptions that are PIMS (potentially inappropriate medications) as defined according to the Beers criteria prescribed to adults aged 65 and older and discharged from the ED. | Discharge prescriptions for Veterans 65 and older at EQUIPPED implementation sites within each group | Posted | Count of Units | Prescriptions | 12-Months Post Implementation of EQUIPPED | Prescriptions | Prescriptions |
|
AEs, SAEs, and UAPs were collected from the time at study entry until the end of study participation (an average of 1 year, 6 months).
Adverse events were related to distress from survey questions or data breaches.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Active Feedback | EQUIPPED with active provider feedback, implementing one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise. EQUIPPED with Active Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The active feedback group will receive one-to-one (1:1) in-person academic detailing from a professional colleague that includes in-person audit, feedback, and peer benchmarking and provide on-site expertise. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Elizabeth Camille Vaughan/ Atlanta Site Section Chief Birmingham/Atlanta GRECC | Atlanta VAHCS | 404 315 4100 | 373118 | elizabeth.vaughan2@va.gov |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot | Yes | No | No | Study Protocol | Jun 25, 2021 | Dec 26, 2023 | Prot_000.pdf |
| SAP | No | Yes | No | Statistical Analysis Plan | Aug 28, 2018 | Dec 26, 2023 | SAP_001.pdf |
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| ID | Term |
|---|---|
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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In order to inform a Veterans Affairs (VA) system-wide approach to improve prescribing safety for older Veterans, the investigators will conduct a randomized study to determine best practices for influencing provider prescribing behavior in order to decrease PIMs prescribed for older Veterans at the time of ED discharge. The overall goal of this project is to determine which EQUIPPED implementation strategy (active or passive feedback) is most effective to reduce prescribing of PIMs for older Veterans discharged from the ED. Eight sites will be randomized to either active feedback with individual, in-person academic detailing or passive feedback delivered via an individualized electronic dashboard.
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|
| EQUIPPED with Passive Feedback | Other | Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. |
|
| 12-Months After the Delivery of the First EQUIPPED Report |
| Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention | Micro-costing of the intervention will be done to learn details of specific factors that may impact the cost of the intervention to the Veterans Health Administration (organization) | 12-Months Post Implementation of EQUIPPED |
| Decatur |
| Georgia |
| 30033-4004 |
| United States |
| Durham VA Medical Center, Durham, NC | Durham | North Carolina | 27705-3875 | United States |
| VA Salt Lake City Health Care System, Salt Lake City, UT | Salt Lake City | Utah | 84148-0001 | United States |
| Result |
| Burningham Z, Jackson GL, Kelleher JL, Morris I, Stevens MB, Cohen J, Maloney G, Sauer BC, Halwani AS, Chen W, Vaughan CP. Use of a Medication Safety Audit and Feedback Tool in the Emergency Department Is Affected by Prescribing Characteristics. Appl Clin Inform. 2023 Aug;14(4):684-692. doi: 10.1055/s-0043-1771393. Epub 2023 Aug 30. |
| 36790188 | Result | Vaughan CP, Burningham Z, Kelleher JL, McGwin G, Jasien CL, Hastings SN, Stevens MB, Morris I, Jackson GL; The EQUIPPED VA Implementation QI Group. A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program. Acad Emerg Med. 2023 Apr;30(4):340-348. doi: 10.1111/acem.14697. Epub 2023 Mar 8. |
| BG001 | Passive Feedback | EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. EQUIPPED with Passive Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. |
| BG002 | Total | Total of all reporting groups |
| Sites |
|
| Count of Participants |
| Participants |
| Participants |
|
|
| Sex: Female, Male | Self-reported gender, not required to report | Count of Participants | Participants | Participants |
|
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants | Participants |
|
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| Race (NIH/OMB) | Count of Participants | Participants | Participants |
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| Region of Enrollment | Count of Participants | Participants | Participants |
|
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| Total Number of Discharge Prescriptions for Older Adults | Total number of prescriptions ordered for adults 65 years of age and older at discharge in the 6 month period before EQUIPPED program implementation by randomization group | Number | Prescriptions | Sites |
|
|
| OG001 | Passive Feedback | EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. EQUIPPED with Passive Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. |
|
|
| Secondary | Social Cognitive Theory Survey - Perceived Control Domain | Prescribers at participating EDs completed a survey at baseline, 6, and 12 months to assess perceived control related to prescribing as a factor that could be impacted by the EQUIPPED intervention. The outcome relates to the average reported perception of 'control' across site respondents by implementation group assignment. The 'perceived control' domain is assessed with a 1-5 Likert scale where 1=strongly disagree and 5=strongly agree with the statement, "I am in control of reducing the potentially inappropriate medications that I prescribe for older Veterans at the time of emergency department." | This outcome measure was assessed at the site level | Posted | Mean | Standard Deviation | units on a scale | 12-Months After the Delivery of the First EQUIPPED Report | Sites | Sites |
|
|
|
| Secondary | Micro-Costing the Active and Passive Feedback Versions of the EQUIPPED Intervention | Micro-costing of the intervention will be done to learn details of specific factors that may impact the cost of the intervention to the Veterans Health Administration (organization) | This outcomes measure was assessed at the site level. Total cost to the organization based on allocation group (4 sites per group) | Posted | Number | Dollars | 12-Months Post Implementation of EQUIPPED | Sites | Sites |
|
|
|
| 0 |
| 36 |
| 0 |
| 36 |
| 0 |
| 36 |
| EG001 | Passive Feedback | EQUIPPED with passive provider feedback, implementing monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. EQUIPPED with Passive Feedback: Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED is a multi-component program to reduce the prescribing of potentially inappropriate medications (PIMs) to older adults upon discharge from the Emergency Department (ED). It has three core components: 1) provider education, 2) Electronic Health Record (EHR)-based clinical decision support (CDS) including pharmacy quick order sets to facilitate provider order entry, and 3) provider audit and feedback with peer benchmarking. The passive feedback group will receive monthly provider feedback via an electronic dashboard with audit, feedback and peer benchmarking. | 0 | 38 | 0 | 38 | 0 | 38 |
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| Unknown or Not Reported |
|
| Native Hawaiian or Other Pacific Islander |
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| Black or African American |
|
| White |
|
| More than one race |
|
| Unknown or Not Reported |
|
|